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Follow-Up Matters 988 Suicide and Crisis Lifeline Available 24/7 988 Suicide and Crisis Lifeline Available 24/7 Follow-Up Care Partnerships Emergency Departments About Liability Research & Data More Crisis Care ProgramsMenu Stop Skip Intro / Enter Site ► 20% * See Supporting Data fewer suicides With effective follow-up support, we can reduce suicide in individuals discharged from hospitals by 20% nationally. 43% * See Supporting Data of suicides occur within a month of discharge from a hospital. 47% of those individuals died before their first follow-up appointment. lower risk * See Supporting Data When connected with a Crisis Center for follow-up, individuals reported less stress and lower risk of suicide. See Additional Supporting Data 91% * See Supporting Data of 988 Centers provide follow-up services. Additionally, 38% of 988 Centers have formal relationships with their local Emergency Departments. Follow Up Matters * See Supporting Data Follow-Up care saves lives and resources. Follow-up care allows hospitals and insurance companies to save money and re-direct their resources to necessary visits. See Additional Supporting Data ◄ Return to Main Screen Suicide within 12 months of contact with mental health services: National clinical survey SOURCE: Appleby, L., et al. (1999). "Suicide within 12 months of contact with mental health services: National clinical survey." British Medical Journal 318: 1235-1239. Read Source Online OBJECTIVE: To describe the clinical circumstances in which psychiatric patients commit suicide. DESIGN: National clinical survey. Setting: England and Wales. Subjects: A two year sample of people who had committed suicide, in particular those who had been in contact with mental health services in the 12 months before death. MAIN OUTCOME MEASURES: Proportion of suicides in people who had had recent contact with mental health services; proportion of suicides in inpatients; proportion of people committing suicide and timing of suicide within three months of hospital discharge; proportion receiving high priority under the care programme approach; proportion who were recently non-compliant and not attending. RESULTS: 10 040 suicides were notified to the study between April 1996 and March 1998, of whom 2370 (24%; 95% confidence interval 23% to 24%) had had contact with mental health services in the year before death. Data were obtained on 2177, a response rate of 92%. In general these subjects had broad social and clinical needs. Alcohol and drug misuse were common. 358 (16%; 15% to 18%) were psychiatric inpatients at the time of death, 21% (17% to 25%) of whom were under special observation. Difficulties in observing patients because of ward design and nursing shortages were both reported in around a quarter of inpatient suicides. 519 (24%; 22% to 26%) suicides occurred within three months of hospital discharge, the highest number occurring in the first week after discharge. 914 (43%; 40% to 44%) were in the highest priority category for community care. 488 (26% excluding people whose compliance was unknown; 24% to 28%) were non-compliant with drug treatment while 486 (28%; 26% to 30%) community patients had lost contact with services. Most people who committed suicide were thought to have been at no or low immediate risk at the final service contact. Mental health teams believed suicide could have been prevented in 423 (22%; 20% to 24%) cases. CONCLUSIONS: Several suicide prevention measures in mental health services are implied by these findings, including measures to improve compliance and prevent loss of contact with services. Inpatient facilities should remove structural difficulties in observing patients and fixtures that can be used in hanging. Prevention of suicide after discharge may require earlier follow up in the community. Better suicide prevention in psychiatric patients is likely to need measures to improve the safety of mental health services as a whole, rather than specific measures for people known to be at high risk. Key messages Around a quarter of people who commit suicide have been in contact with mental health services in the year before death[—]over 1000 cases annually Of these cases, 16% are psychiatric inpatients and 24% have been discharged from inpatient care in the previous three months Problems of observation caused by ward design and nursing shortages are common in cases of inpatient suicide Suicide in former inpatients occurs most commonly in the week after discharge Non-compliance with treatment and loss of contact with services are common before suicide ◄ Return to Main Screen Suicide in recently discharged psychiatric patients: a case-control study. SOURCE: Hunt, I. M., et al. (2009). Suicide in recently discharged psychiatric patients: a case-control study. Psychological Medicine 39: 443-449. Read Source Online BACKGROUND: Few controlled studies have specifically investigated aspects of mental health care in relation to suicide risk among recently discharged psychiatric patients. We aimed to identify risk factors, including variation in healthcare received, for suicide within 3 months of discharge. METHOD: We conducted a national population-based case-control study of 238 psychiatric patients dying by suicide within 3 months of hospital discharge, matched on date of discharge to 238 living controls. RESULTS: Forty-three per cent of suicides occurred within a month of discharge, 47% of whom died before their first follow-up appointment. The first week and the first day after discharge were particular high-risk periods. Risk factors for suicide included a history of self-harm, a primary diagnosis of affective disorder, recent last contact with services and expressing clinical symptoms at last contact with staff. Suicide cases were more likely to have initiated their own discharge and to have missed their last appointment with services. Patients who were detained for compulsory treatment at last admission, or who were subject to enhanced levels of aftercare, were less likely to die by suicide. CONCLUSIONS: The weeks after discharge from psychiatric care represent a critical period for suicide risk. Measures that could reduce risk include intensive and early community follow-up. Assessment of risk should include established risk factors as well as current mental state and there should be clear follow-up procedures for those who have self-discharged. Recent detention under the Mental Health Act and current use of enhanced levels of aftercare may be protective. ◄ Return to Main Screen An evaluation of crisis hotline outcomes. Part 1: Nonsuicidal crisis callers. SOURCE: Kalafat, J., et al. (2007). "An evaluation of crisis hotline outcomes. Part 1: Nonsuicidal crisis callers." Suicide and Life Threatening Behavior 37: 322-337. Read Source Online THE effectiveness of telephone crisis services/hotlines, examining proximal outcomes as measured by changes in callers’ crisis state from the beginning to the end of their calls to eight centers in the U.S. and intermediate outcomes within 3 weeks of their calls, was evaluated. Between March 2003 and July 2004, 1,617 crisis callers were assessed during their calls and 801 (49.5%) participated in the followup assessment. Significant decreases in callers’ crisis states and hopelessness were found during the course of the telephone session, with continuing decreases in crisis states and hopelessness in the following weeks. A majority of callers were provided with referrals and/or plans of actions for their concerns and approximately one third of those provided with mental health referrals had followed up with the referral by the time of the follow-up assessment. While crisis service staff coded these callers as nonsuicidal, at follow-up nearly 12% of them reported having suicidal thoughts either during or since their call to the center. The need to conduct suicide risk assessments with crisis callers and to identify strategies to improve referral follow-up is...